Photodistributed blue‐gray pigmentation of the skin associated with long‐term imipramine use

Abstract

A 72-year-old white woman presented with progressively increasing slate-gray pigmentation of the face and extensor aspect of the forearms, which she had been suffering from for 8 years. She had been taking imipramine for approximately 30 years. Her other medications included ranitidine and anacin. Physical examination revealed slate-gray hyperpigmentation of the skin photodistributed on the face (Figs 1, 2) and extensor aspects of the forearms. Relative sparing of the skin folds, mucous membranes, sclerae, teeth, and nails was noted. The remainder of the physical examination revealed no abnormalities. Skin biopsy specimens from the right cheek and right forearm were obtained. Histologic examination revealed collections of variably sized, round to ovoid, yellow-brown globular deposits in the upper and mid dermis (Fig. 2). The deposits were identified within macrophages and free within the dermis. The epidermis was unremarkable and free of deposits. The deposits stained for melanin with a Fontana-Masson stain, but did not stain for iron.

Delayed Darkening of Imipramine-Induced Hyperpigmentation after Treatment with a Q-Switched Nd: YAG Laser Followed by a Q-Switched Ruby Laser

“…It is likely that they are imipramine metabolites complexed to melanin granules. Laser treatment of this condition is challenging and somewhat unpredictable because of incomplete understanding of its pathogenesis 1–3 …”

Blue Fingernails during Treatment with Cyclophosphamide for Minimal Change Disease: A Very Rare Side Effect

“…The change of nail color with appearance of a bluegray pigmentation is reported in some clinical conditions, such as HIV [6,7], but it is much more frequently associated to some drugs, such as gefitinib [8], sparfloxacin [9], azidothymidine [10], hydroxyurea [11], imipramine [12], minocycline [13,14].…”

Imipramine-Induced Facial Pigmentation: Case Report and Literature Review

“…[1][2][3][4][5][6][7] All were adults treated for depression, their ages ranging from 46 to 75 years. It should be noted that nine patients were female, 2-6 perhaps reflecting the higher incidence of depression in women.…”